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General NPI Number Information
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NPI Number | 1881551984
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Entity Type | Organization
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Legal Business Name | MAMMJA LLC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 9945 COVENTRY CT
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City | MASON
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State | OH
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Zip | 45040-9537
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Country | US
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Telephone | 513-307-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 9378 S MASON MONTGOMERY RD
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City | MASON
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State | OH
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Zip | 45040-8827
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Country | US
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Telephone | 513-307-5683
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Fax |
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Authorized Official
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Title or Position | ASSOC. DIRECTOR
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Name | JEANENE NMN GIBSON
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Credential | RN
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Telephone | 513-307-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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